French bean counters weigh herceptin vs lapatinib

[Lani]

BUT THEY DON"T understand that the two drugs are not equivalent!!!!!!



J Med Econ. 2012 Sep 12. [Epub ahead of print]
Budget impact analysis of the use of oral and intravenous anticancer drugs for the treatment of HER2-positive metastatic breast cancer.
Benjamin L, Buthion V, Iskedjian M, Farah B, Rioufol C, Vidal-Trécan G.
Abstract
Abstract Objectives: This study aimed at comparing the budgetary impact of two anticancer drugs currently approved for the treatment of HER2-positive metastatic breast cancer (MBC) from the French Health Insurance perspective: trastuzumab-based therapy (TBT) administered intravenously and lapatinib, a self-administered oral dual therapy with capecitabine (L+C) for patients who continue to progress despite TBT. Methods: A budget impact analysis was performed on a 3-year time horizon (2012-2014) to simulate a dynamic cohort of 4 182 HER2-positive patients with a progressing MBC treated with TBT (73%) and L+C (27%). The model was adjusted on progression-free survival (PFS). Office visits, clinical evaluations, drug acquisition and administration costs and transportation costs obtained from the literature and published databases were considered. Results: In the base case analysis (2012), the annual treatment cost per patient for TBT (36 570€) was two times higher than that of L+C (17 179€). Using L+C for all patients (N= 4 182) would avoid €9.7 million of drug administration and transportation costs. Hospital costs represented 1% vs. 87% while community costs represented 99% vs. 13% of L+C and TBT treatment costs, respectively. The lack of direct comparison PFS and treatment dosage modification data were the main limitations. However, no major changes from baseline results were observed from sensitivity analyses. Conclusions: Despite a slightly higher acquisition cost, the treatment cost of L+C remains lower than that of TBT and is the only approved anti-HER2 treatment for HER2-positive patients with progressing MBC. Based on this, it seems important to consider the potential savings for the Health Insurance with the use of oral drug due to the reduction of outpatient hospitalizations. Such reductions may result in a subsequent budget reduction for hospitals but may also provide those facing with acute medical activity with opportunities to better manage other diseases whose treatment cannot be externalized.
PMID: 22970840 [